Sleep problems prevalent for military members

Improving the quality and quantity of U.S. military members' sleep following deployment could help reduce other health problems, including depression and post-traumatic stress disorder, according to a new RAND Corporation study.

However, a lack of consistent and transparent sleep-related policies may impede efforts to promote sleep health among service members, researchers say.

"The U.S. military has shifted from combat operations in Iraq and Afghanistan toward helping service members and veterans reintegrate into noncombat roles," said Wendy Troxel, co-leader of the study and a behavioral scientist at RAND, a nonprofit research organization. "One issue that is often overlooked once military men and women return home is that of persistent sleep problems, because in many ways such problems are viewed as endemic to military culture."

Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems. Sleep problems often follow a chronic course, persisting long after service members return home from combat, with consequences for their reintegration and the readiness and resiliency of the force, researchers say.

The RAND report is the first comprehensive review of sleep-related policies and programs across the U.S. Department of Defense, examining the frequency of sleep disorders and factors that contribute to the problem. A survey of nearly 2,000 service members from all branches of the U.S. military found sleep problems had negative effects on mental health, daytime functioning and perceived operational readiness.

"Military policies on prevention of sleep problems are lacking, and medical policies focus on treating mental disorders that are often linked with sleep problems, instead of sleep itself," said Regina Shih, project co-leader and a senior social scientist at RAND. "We know that sleep problems may precede the onset of mental disorders."

While there may be stigma about seeking sleep treatment, it may be lower than the stigma associated with seeking help for mental health problems. Researchers say this suggests sleep could be a gateway to improving psychological health and readiness in service members.

Researchers say that historically, military cultural attitudes have tended to discount the importance of sleep. For example, service members noted that depriving oneself of sleep is often seen as a badge of honor and acknowledging the need for sleep can be seen as a sign of weakness.

The study recommends widespread education and awareness programs within the Defense Department as one means of shifting these cultural attitudes. In operational contexts, the military emphasizes mission first and the need for sleep may be sacrificed for operational demands. Policies are needed to educate service members and leaders about the importance of sleep, including awareness on the importance of sleep for resilience.

Leaders are not always sure how to develop and execute sleep plans that can balance circadian rhythms with the realities of operational environments, or how to allow for adequate recovery periods after extended sleep deprivation in order to optimize force readiness.

The RAND study presents 16 policy recommendations to help the military improve the prevention, identification and treatment of sleep problems in service members. Those policies fall under four broad categories: prevention of sleep problems; increasing identification and diagnosis of sleep problems; ways to clinically manage sleep disorders and promote sleep health; and ways to improve sleep in training and operational contexts.

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The study, "Sleep in the Military: Promoting Healthy Sleep in U.S. Servicemembers," is available at http://www.rand.org. Other authors include Eric Pedersen, Lily Geyer, Michael P. Fisher, Beth Ann Griffin, Ann Haas, Jeremy Kurz and Paul Steinberg.

Support for the study was provided by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense intelligence community.

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